H&I 2 Exam 2

A client who denies having any health problems reports taking gemfibrozil. Which question does the nurse ask to determine the reason for the medication? "Have you ever experienced an irregular heartbeat?" "Have you been told that you have high blood pressure?" "Have you been told that your cholesterol is too high?" "Have you been instructed to check your blood sugar?"

"Have you been told that your cholesterol is too high?"

The nurse cares for a client newly diagnosed with multiple sclerosis (MS). The nurse recognizes further education is needed based on which client statement? "I should remove the throw rugs from my home." "I need to drink about 2 liters of fluid per day." "I should take a hot bath or shower every day." "I need to avoid contact with people who are sick."

"I should take a hot bath or shower every day" since MS causes nerves to lose their myelin sheath it makes MS patients more vulnerable to heat and temperature changes; heat can cause or exacerbate manifestations of the disease

A client diagnosed with primary hypertension asks the nurse about risk factors for this condition. The nurse confirms the client's understanding of teaching with what response? "Taking too much ibuprofen increases my risk." "Lack of exercise makes hypertension more likely." "I may be eating too much dietary sodium." "Obesity often leads to primary hypertension." "My kidney disease worsened my blood pressure."

"Obesity often leads to primary hypertension" Nephrotoxic drugs and chronic kidney disease are common causes of secondary hypertension

Unstable angina

"Pre-infarction" Occurs at rest and more frequently Not relieved by rest and NTG *constant pain*

Clinical manifestations of hypertension

"Silent killer" Fatigue Dizziness Palpitations Angina Dyspnea Headache

Stable angina

"predictable" occurs with exertion -goes away after demands dec -relieved by rest -blockage starting

MAP

(SBP + 2DBP)/3

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What is somogyi effect and what is it caused by?

*Hypoglycemia around 3-4 am* —> body boosts growth hormone and cortisol —> *hyperglycemia at 8 am*. Typically means a pt has not had enough food at bedtime

Tx for DM type 1

*Insulin* -individual plan -education -lifestyle modifications -diet, my plate for DM (1/2 veggies, 1/4 starch, 1/4 lean Protien, +dairy & fiber)

Prevention of heart diseases (HTN, CAD)

*Nurse Education Healthy diet, no smoking, regular exercise, alcohol in moderation, controlling blood pressure, medications, *early recognition & management* - improve QOL

Define Pulmonary circulation

*a low-pressure system*; moving blood from the right side of the heart to the lungs (pulmonary arteries/capillaries/veins) and back to the left side of the heart

Rheumatoid arthritis

*autoimmune*, systemic, relapsing-remitting, *degenerative* -*inflammation* in the synovial tissue

Inflammation

*non specific response* an invasion of tissue by pathogens (viruses, bacteria, fungi, and paracytes) Infection has to be recognized on time and treated with hydration and antibiotic Infection can start local and spread systemic to *bacteremia and sepsis*

Common s/sx of DM Type 2

- 3 polys - muscle wasting - vision changes - numbness and tingling in hands or feet - dry skin - skin lesions that are slow to heal

Common s/sx of DM Type 1

- 3 polys - polyuria, polydipsia, polyphagia - nausea - severe vomiting - abdominal pains

Pathophysiology of type 1 diabetes

- Caused by an autoimmune response - Beta cells in the pancreas fail to produce insulin - The cells are starved of glucose since there is no insulin - The cells start to break down protein and fat into energy, causing ketones to build up —> acidosis

HTN meds

- Diuretics (Hydrochlorothiazide) - ACE inhibitors (Lisinopril) - Beta blockers (Metoprolol) - Ca+ channel blockers (Diltiazem, amlodipine) - Cardiac glycoside (Digoxin) - Statins (atorvastatin) - Anticoagulants (Heparin) - Vasodilators (nitroglycerin) - ARBs (Losartan)

Treatment of HHS

- Fluid replacement - correction of electrolyte imbalance - insulin administration (SQ) - Since this is commonly seen in elderly population, closely monitor for fluid overload and cardiac dysrhythmias

Potential complications of DKA & HHS

- Fluid volume overload - pulmonary edema - heart failure - hypokalemia - hyperglycemia and ketoacidosis (w/ DKA only) - Hypoglycemia (after treatment administered) - Cerebral edema

signs/symptoms of HHS

- Hyperglycemia (usually > 600+) - Serum osmolality >350 mOsm/L - no acidosis present

diagnostic and lab tests to determine an individual's perfusion status

- Lipid panel Triglycerides Total cholesterol LDL HDL - Cardiac enzymes myoglobin CK-MB Troponin I Troponin T WBC - Kidney function tests BUN Creatinine GFR

Management of a patient with CAD

- Lipid-lowering medications (statins) - Heart-healthy diet (DASH diet) - Increased physical activity - Smoking cessation - Hypertension management - Diabetes management

Nursing interventions for DKA and HHS

- Maintaining fluid and electrolyte balance - Increasing knowledge about diabetes management - Decreasing patient anxiety - Monitoring and managing potential complications (fluid volume overload, hypokalemia, cerebral edema)

A client diagnosed with type 2 diabetes, hypertension, and heart failure is prescribed hydrochlorothiazide. The nurse instructs the client to take what actions while on this medication? Select All that Apply: Notify the healthcare provider if heart rate is under 65 beats/min. Increase daily intake of foods high in calcium, like yogurt. Monitor weight each morning in the same clothes after voiding. Increase the frequency of blood glucose monitoring. Increase daily intake of foods high in potassium, like avocados.

- Monitor weight each morning in the same clothes after voiding - Increase the frequency of blood glucose monitoring. - Increase daily intake of foods high in potassium, like avocados

Identify priorities for management of patients with wounds

- Poor perfusion can lead to new wounds and/or poor wound healing - RN role is to educate and intervene to improve perfusion - Perfusion issues such as HTN, CAD, DM and blood stasis can contribute to wound formation and poor wound healing

Pathophysiology of HHS

- Relative insulin deficiency typically initiated by an illness that raises demand for insulin. Lack of effective insulin causes osmotic diuresis which leads to loss of water and electrolytes. - To maintain osmotic equilibrium water shifts from intracellular to extracellular fluid space, resulting in dehydration, glycosuria, hypernatremia, and increased osmolarity - Some insulin present so it does not create ketones

Nursing diagnoses for DKA & HHS

- Risk for fluid volume deficit related to polyuria and dehydration - Risk for electrolyte imbalance related to fluid loss or shifts - Deficient knowledge about diabetes self-care skills or information

assessment methods used to assess perfusion

- Total body water decreases to 45% —> higher risk for dehydration - Heart contractility lowers —> pulm HTN & pulm edema - sedentary lifestyle - takes longer to heal from illnesses and for wounds to heal -General appearance -skin and extremities -Level of consciousness and orientation -chest pain/discomfort -Presence of varicose veins -unusual fatigue -syncope (fainting) -capillary refill -peripheral pulses

S/Sx of decreased perfusion

- chest pain - unusual fatigue - weakness - shortness of breath - edema - syncope - muscle cramps - tingling and numbness - pallor - diaphoresis - increased capillary refill time - no peripheral pulses - Decreased LOC

"Sick day" rules for diabetic patients

- do NOT stop taking insulin; can result in DKA - stay hydrated - take small portions of food - if nausea/vomiting for >6hrs call medical provider

Signs and symptoms of DKA

- ketosis & acidosis - hyperglycemia - dehydration - Kussmaul respirations - acidic / fruity breath

MS assessment

- neurological deficits- secondary complications- impact of disease on physical, social, and emotional function and lifestyle- patient and family coping

What would you do as a nurse if you were asked to perform a focused assessment surrounding metabolism?

- nutritional and functional status of the patient - intake/output - blood sugar - LFTs - Kidney function tests - activity tolerance - bowel sounds - muscle mass and skin turgor

nursing interventions to promote perfusion

- smoking cessation - DASH diet - increased activity - weight loss -hydration - management of HTN - management of DM - Stress management -frequent screening

Type 1 DM

-autoimmune -can be genetic -Beta cell destruction -*absolute deficiency of insulin* -hyperglycemia -> *DKA* -> coma -> death

Type 2 DM

-insulin resistance or deficiency - usually dx in adulthood - environmental/lifestyle related, *obesity*, sedentary lifestyle, HTN, CAD, metabolic syndrome, race/ethnicity - hyperglycemia -> *HHS*

Pulmonary artery disease

-narrowing artery lumen -arteriosclerosis -claudication -non-healing wounds -gangreene -diabetic wounds

MS dx

-not one specific test -rule out other dx - MRI, CT,

MS tx meds

-spasms: baclofen - fatigue: amantadine, propranolol - ataxia: gabapentin, clonazepam -bowel/bladder: anticholinergic & antispasmodic, antibiotics

PE sx

-sudden chest pain -dyspnea -RHF

Side effect of DMARDS

-suppress immune system -flu like sx -allergic rxn

DVT sx

-swelling -redness -warmth -pain ~or~ -symptomatic

RA dx

-symptoms -labs (not specific): show inflammation -Atherectomies - analyze synovial fluid -Xray CT

Patho of coronary artery disease

-vessel injury -inflammation -endothelium changes -fatty streaks -atheroma (plaque formation) -vessel obstruction or low blood flow (↑BP) -dislodgment - embolism -acute coronary syndrome -angina -MI -death

Serum creatinine levels

0.6-1.2 mg/dL "above 13 is bad for __________"

Hypersensitivity reactions

1. Immediate - anaphylaxis - sec-min -systemic 2. Cytotoxic - blood transfusions - min-hrs -systemic 3. Immune complex - Autoimmune disease -Immune system attacks self -Chronic -Systemic 4. Delayed - contact dermatitis -48hrs later -local rxns

MS nursing diagnosis

1. Impaired physical mobility r/t neuromuscular impairment secondary to demyelination 2. Self-care deficit r/t reduced neurotransmission and impaired physical mobility secondary to demyelination 3. Impaired coping, depression r/t the chronic, progressive nature of the disease

RA meds

1. NSAIDs: ibuprofen, naproxen (better than opioids in this case) 2. DMARDs (disease modifying anti-rheumatic drugs)- *non-biological: cyclosporine, sulfasalazide, hydrochloroquine, methotrexate (suppress immune) *biological: interleukin-1 or interleukin-6 monoclonal antibodies: Remicade & Humira 3. Corticosteroids 4. Immunosuppressants: Cyclophosphamide, cyclosporine, azathioprine 5. PT/OT

The nurse explains risk factors for heart failure (HF) to a client. Which factors are considered extrinsic factors? Select all that apply: Diet and weight Pregnancy Coronary artery disease Hypertension Dysrhythmias

Diet and weight Hypertension Coronary artery disease

Dx of venous disorders

1. Prevent further clotting - heparin - thrombolytic therapy (blood thinning and dissolve clot) - alteplase, TPA -pT/aPTT/INR -CBC, Protien -ABI 1-1.4 normal <0.9 abnormal

Treatment of anaphylaxis

1. Prevention 2. Epinephrine (Epi-pen) 3. Anti-inflammatory -Corticosteroid, Mast cell stabilizers 4. IV fluids 5. Immunotherapy -omalizumab

Tx of type 2 DM

1. Prevention (in pre-diabetes) 2. Slow progression of disease - education -lifestyle modification -diet my plate -anti-diabetics (metformin, glucofed) -insulin (as disease progresses)

Treatment for DKA

1. Rehydration - fluid replacement 2. Reverse Acidosis - IV insulin 3. Restore Electrolytes - correction of electrolyte imbalances -*check for K levels - Hyperkalemia - kayaxalte

4 stages of infection

1. incubation 2. prodromal stage 3. illness stage 4. convalescence

Digitalis

Digoxin - antihypertensive, rate and rhythm control

Factors influencing BP

1. sympathetic NS - baroreceptors in aortic arch & corotic sinus (vasoconstriction/dilation) 2. Circulating Epi & Norepi (vasoconstrict) 3. RAAS (vasodilate) 4. ADH (vasopressor) 5. ANP & BNP - in response to stretching in aorta due to excess blood volume

Immune system function

1. to protect your body by killing foreign organisms 2. recognize self from non-self

3 stages of inflammation

1. vascular/cellular - vasodilation, erythema 2. Exudate production - drainage, pus 3. Reparative - granulation, fibrous tissue, collagen

Non-Specific immunity

1st line of defense - skin mucus membranes, cillary movement, tears, urine, sweat, salavia, GI content, *inflammation*

Ca Channel Blockers

Diltiazem (peripherally specific - antiarrhythmic), Amlodipine (cardiovascular specific) -antihypertensive Side effects: headache dizziness arrhythmias bradycardia constipation

What causes cerebral edema in a patient with HHS or DKA?

Exact cause is unknown but rapid correction of hyperglycemia, resulting in fluid shifts, is thought to be the cause. Can usually be prevented with gradual reduction in blood glucose level

When someone presents with a hypertensive emergency, by what percentage do you want to lower their BP?

20-25%; don't let MAP drop below 60

Myoglobin levels

25 - 75 ng/ml

S/Sx of hyperglycemia

3 polys - polyuria, polydipsia, polyphagia

Ideal HBA1C

4-6% (above 5.7% is pre-diabetic)

BUN levels

7-14 mg/dL

Blood glucose goal

70-100 mg/dL

post-prandial (after a meal) blood glucose levels

90 - 200 mg/dL

GFR levels

90-120 mL/min

Troponin I levels

< 0.03 ng/mL

Troponin T levels

< 0.1 ng/mL

LDL levels

<100 mg/dL

Triglyceride levels

<160 mg/dL

Total cholesterol levels

<200 mg/dL

CK-MB levels

<5 ng/mL

hypoglycemic blood sugar levels

<70 mg/dL

Fasting blood glucose that could indicate DM

> 126 mg/dL

Random blood glucose that could indicate DM

> 200 mg/dL

HBA1c levels that would indicate diabetes

> 6.5%

HDL levels

>40 mg/dL

At discharge, a client with heart failure due to systolic dysfunction is prescribed lisinopril, an angiotensin-converting enzyme (ACE) inhibitor. Which teaching does the nurse include for this medication? Select All that Apply: A "It relaxes blood vessels, which lowers blood pressure." B "It is safe to take during pregnancy." C "This drug may contribute to hyperkalemia." D "Report a cough immediately." E "This drug can make it easier to exercise."

A, C & E

The laboratory results of the client with a history of exertional angina reveal cholesterol of 180 mg/dL, LDL of 175 mg/dL, HDL of 30 mg/dL, and troponin of 0.016 ng/mL. The nurse performs which interventions based on these results? Select all that apply: Give the client sublingual nitroglycerin. Teach the client about a heart-healthy diet. Assess the client's exposure to cigarette smoke. Administer the client's scheduled atorvastatin. Provide the client oxygen via nasal canula.

Administer the client's scheduled atorvastatin

A nurse plans care for a client with acute decompensated heart failure. Which interventions assist the nurse in improving the client's cardiac output? Select all that apply: Treat elevated temperature quickly. Assess fluid intake and output. Provide a restful environment. Assist with breathing exercises when dyspnea occurs. Place patient in upright position. All of the above

All of the above

The healthcare provider (HCP) prescribes amlodipine for a client with hypertension. The nurse teaches the client about which reaction to amlodipine? Select all that apply Flushing Shortness of breath Edema Palpitations Constipation All of the above

All of the above

A client has newly been prescribed enalapril for hypertension. The nurse withholds the enalapril and notifies the health care provider for which findings? Select All that Apply: An orthostatic drop of 20 mm HG in diastolic BP Serum potassium level of 3.2 mmol/L (mEq/L) A persistent, mild, nonproductive cough Swelling of the lips without presence of a rash An increase in urine output in the last 24 hours

An orthostatic drop of 20 mm Hg in diastolic BP Swelling of the lips without presence of a rash

Tx of infection

Antibiotics Antifungals Antipyretics Antiemetic Antiviral Analgesics Anti-infectious

Patho of Anaphylaxis

Antigen (trigger: allergy, food, dust) -> B cells triggered -> ↑IgE -> ↑mast cells -> ↑ histamine -> leaking capillaries - *vasodilation* -> ↑mucus - *bronchoconstriction* -> anaphylactic shock -> rep failure, cardiogenic shock

CAD meds: Anti-platelets

Aspirin, Clopidogrel reduce chance of MI

A client is admitted to the hospital with severe headache, tinnitus, and a BP of 202/122 mmHg after running out of medications. After being treated for hypertensive emergency, which approach by the nurse at discharge is best? Instruct the client's spouse to manage medication. Instruct the client to count the number of pills left at home. Assess for barriers to taking the prescribed medication. Tell the client to purchase a medication organizer.

Assess for barriers to taking the prescribed medication.

CAD meds: Statins

Atorvastatin, Simvastatin ↓Chol, ↓LDL, ↓TG, ↓HDL Side effects: Myalgia, Myopathy (will go away) NO grapefruit

The nurse prepares a client with multiple sclerosis for discharge. Which instructions are included in the discharge paperwork? Select All That Apply: Follow a gluten-free dietary plan. Establish a daily, vigorous exercise routine. Avoid the use of saunas and hot tubs. Establish daily routines for activities. include 25-35 grams of dietary fiber daily.

Avoid saunas and hot tubs Establish daily routines for activities Include 25-35g of daily fiber in diet

Humoral branch

B-cells *make antibodies* - primary response in 3 days, secondary response in 24hrs (memory cells) -circulates in body fluids Antibodies: IgM - primary response IgG - 2ndary response IgA - Resp, GI IgD IgE - Allergy - hypersensitivity rxn

Pulmonary Embolism

Blood clot in pulmonary artery -> ischemia & infarction of lung tissue - obstruction of pulmonary artery

When caring for a client with mitral valve stenosis (L sided heart failure), the nurse monitors for what symptoms associated with this condition? Select all that apply: Blood-tinged sputum Fatigue Respiratory alkalosis Edema in the legs Hypoventilation

Blood-tinged sputum Fatigue Edema in legs Hypoventilation

BP

CO x SVR

Calculate CO if SV=70 HR = 75

CO= 70X75 CO= 5250 ml ~5.25 L blood pumped in 1 min

The nurse cares for a client with a newly diagnosed acute infection. The client's medical history includes type 1 diabetes mellitus. The nurse provides which education upon discharge? Monitor blood sugars at least twice per day. Hold fast-acting insulin if blood sugar is normal before a meal. Check for urine ketones if blood sugars exceed 300 mg/dL. Limit fluid intake when blood sugars are above 250 mg/dL.

Check for urine ketones if blood sugars exceed 300 mg/dL

CAD meds: Bile Acid Sequestrants

Cholestyramine ↓LDL, ↓Chol absorption, ↑HDL

patho of Guillain-barre syndrome

Circulating antibody attacks the myelin sheaths of the peripheral nerves (PNS), removing their insulation

A nurse teaches a client about hypoglycemia awareness. Which signs and symptoms does the nurse include in the client teaching? Select All That Apply: The client may experience polyuria. The client may experience polydipsia. The client may experience weakness. The client may experience diaphoresis. The client may experience hunger.

Client may experience weakness, diaphoresis, and hunger

Vasodilator besides nitro

Clonidine

Sx of MS

Cognitive/emotional: depression, loiliness, irritability, mood swings, forgetfulness, change in LOC Sensory: pain, spasticity, bowel and bladder issues - urgency and retention, sexual dysfunction, visual disturbances, loss of balance Motor: ataxia, muscle hypertrophy, loss of balance, loss of coordination

A client with no previous cardiac history reports central chest pain. Which data does the nurse gather prior to administering the immediate prescription for sublingual nitroglycerin? Select all that apply: Time of last oral intake Current blood pressure Oxygen saturation Medications in past 24 hours Current heart rate

Current blood pressure Current heart rate

Which diabetic complication involves acidosis and ketosis? HHS or DKA?

DKA

Nocturnal/Pritzmetal angina

pain occur mostly when lying down at night -spasms of coronary artery

5 cardinal signs of inflammation

pain, swelling, heat, redness, impairment

Native/Innate Immune System

present at birth; non-specific immune response; first line of defense; uses monocytes, macrophages, dendritic cells, natural killer (NK) cells, basophils, eosinophils, and granulocytes

which stage of infection involves initial appearance of mild symptoms?

prodromal stage

CAD meds: PCSK9 inhibitors

promote cholesterol clearance ↓LDL

Symptoms related to organ damage from hypertension

retinal and other vision changes renal damage myocardial infarction cardiac hypertrophy stroke

MS temp

sensitive to hot and cold temperatures -most sensitive to cold -AC staying out of the heat - not extreme cold

Modifiable risk factors for decreased perfusion

smoking poor diet sedentary lifestyle DM 2 Obesity Stress HTN dyslipidemia

How would you educate a patient to take nitroglycerin?

take at onset of chest pain up to 3x; one every 5 minutes if symptoms persist after 3rd dose, call 911

Describe the scope of perfusion

the continuum of the hearts ability to supply blood and patency of the arteries to adequately supply blood to peripheral tissues Normal perfusion -> Ischemia (insufficient perfusion - cell death) -> Infraction (Necrosis - cell death)

Define Perfusion

the flow of blood trough arteries and capillaries delivering nutrients and oxygen to the cells

Active immunity

the immunity that results from the production of antibodies by the immune system in response to the presence of an antigen; acquired via vaccination or environmental exposure

Stages of wound healing

vascular response (clot) inflammatory (neutrophils) proliferation (granulation) remodeling/maturation

What is the large intestine's main role?

water absorption

Pathophysiology of type 2 diabetes

↑BG levels in presence of insulin -insulin resistance (missing receptors to accept insulin to allow glucose into cell) -deficiency of insulin

Pulmonary artery disease PAD treatment

↓ Arstherclosis process - statins, antiplatelets, ACE inhibitors ↓Claudication -Cilostazol - vasodilator -walking 30 min day - cholesterol <200 -Dec sodium <2g/day

CAD meds: Cholestreol absorption inhibitor

Ezetimibe, Omega 3 ↓Chol. absorption, ↓LDL

Loop diuretics

Furosemide, Bumetanide, Torsemide

A client with coronary artery disease and hyperlipidemia takes simvastatin to manage cholesterol. The nurse asks the client about the presence of which common side effect? Select all that apply: Gastric upset Peripheral edema Headache Rash Muscle pain

Gastric upset Headache Muscle pain

CAD meds: Fibrates

Gemfibrozil, Fenofibrate ↓TG, ↓HDL

A client with preeclampsia calls the obstetrics triage unit at night and reports a severe headache with blurred vision. What instruction does the nurse give to this client? Take 650 mg acetaminophen and notify the provider in the morning. Have a family member drive her to the hospital immediately for evaluation. Eat a light snack and lie on her left side for two hours and notify if no relief. Report to a local pharmacy and have her blood pressure evaluated.

Have a family member drive her to the hospital immediately for evaluation.

What lab value is known as the best indicator of a patient's diabetic control and actual long-term blood glucose levels?

HbA1C

The nurse teaches the client about symptoms for hypertension. Additional education is required when the client states which symptom indicates elevated blood pressure? Leg swelling Headaches Blurred vision Head fullness

Head fullness

Anticoagulants

Heparin, Enoxaparin, Warfarin, clopidogrel, prodexa

Cause of gestational diabetes

Hormones secreted by the placenta inhibit the action of insulin

Thiazide diuretics

Hydrochlorothiazide (HCTZ) -antihypertensive Side effects: hypokalemia (decreased potassium) renal failure respiratory distress aplastic anemia hypotension (hold if SBP is <90)

Which immunoglobulin is involved in hypersensitivity reactions?

IgE

Which immunoglobulins cross the placenta?

IgG

Which immunoglobulin is prominent in early immune response and activates compliment system?

IgM

What does CK-MB indicate

It is an enzyme released in the bloodstream when the heart, muscles, or brain becomes damaged

A client requests cholesterol testing. Which lab does the nurse identify as placing the client at risk for coronary artery disease (CAD)? LDL 120 mg/dL Triglycerides 120 mg/dL HDL 24 mg/dL Total cholesterol 180 mg/dL

LDL 120 mg/dL (ideal values < 100) HDL 24 mg/dL (ideal values > 40)

ACE Inhibitors

Lisinopril -antihypertensive Side effects: persistent non-productive/dry cough angioedema (swelling of airway) (should go away in 4 wks) hypotension hyperkalemia liver necrosis

S/sx of RA

Local - symetric -join pain (esp. AM) -stiffness -swelling -warmth -erythema -lack of function -pain Systemic -fever -weight loss -fatigue -anemia -↑ lymph nodes

ARBs

Losartan, Valsartan -antihypertensive Side effects: angioedema dizziness fatigue hyperkalemia muscle weakness

The nurse reviews the health record of a client with coronary artery disease (CAD). When assessing client risk, what elevated lab value is the most likely to cause the progression of CAD? Blood glucose High-density lipoproteins Microalbuminuria Low-density lipoproteins

Low-density lipoproteins

What would be the MAP if BP - 120/80

MAP = 120 + 2(80) / 3 MAP = 28/3 MAP = 93.3

Non-modifiable risk factors for decreased perfusion

Male gender, African American, over 50 years old

Beta Blockers

Metoprolol, Carvedilol -antihypertensive, rate control Side effects: bradycardia (hold if HR <60) orthostatic hypotension bronchospasm masks hypoglycemia

What does high myoglobin indicate

Muscle damage (possible heart damage)

Low levels of _______________ are good for ruling out MI

Myoglobin

Scope of immunity

Normal -> suppressed: HIV, AIDS, Cancer -> Overactive: Hypersensitivity (Allergies), Autoimmune disorders (RA, MS, UC, Crohn's)

Causes of HHS

Often occurs in older adults with no known history of DM or have DM2. Can often be traced to an infection or precipitating event such as acute illness (stroke), medications that exacerbate hyperglycemia (thiazide diuretics), or dialysis treatment

Scope of metabolism

Optimal -> Insufficient - Cachexia (body does not accept nutrition bc its so weak or sick), starvation, malnutrition -> Excess - high cal diet, pre-obesity (obesity is insufficient metabolism)

Management of a patient with HTN

Patient education! - limit sodium intake - limit alcohol intake - DASH diet - smoking cessation - increase daily exercise - teach pt how to measure BP and keep a record - stress reduction

A client is prescribed diltiazem. The nurse assesses which parameter related to the effects of diltiazem? Select all that apply Peripheral edema Heart rhythm Blood pressure Temperature Calcium level

Peripheral edema Heart rhythm (can cause arrhythmias) Blood pressure (can cause hypotension)

A client with hypertension and asthma takes multiple oral medications. The nurse recognizes that which medication places the client at risk for bronchospasm? Amlodipine 5 mg Propranolol 80 mg Lisinopril 5 mg Spironolactone 25 mg

Propranolol 80 mg

A nurse assesses a client with chronic hypertension. What signs does the nurse identify as a chronic complication of hypertension? Select All that Apply: Vomiting Protein in urine Dyspnea at rest Leg pain when climbing stairs Weakness

Protein in urine Dyspnea at rest Weakness Leg pain when climbing stairs

What is down phenomenon and what causes it?

Pt wakes up between *4-8 am with hyperglycemia*. Usually caused by not enough insulin in the afternoon or evening. Dose will likely need to be increased at bedtime

Onset of DKA

RAPID < 24 hours

Insulins

Rapid acting insulin (Lispro [Humalog], Aspart) - Onset <15min, Peak 30-60min, Duration 3-4hr Regular SQ Insulin - Onset 30-60min, Peak 2-3hr, Duration 5-7hrs Intermittent acting (NPH) insulin - Onset 1-2hr, Peak 4-12hr, Duration 18-24hr Long lasting insulin (Lantus glargine [never mix]) - Onset 1hr, Duration 24hrs *Regular only insulin available IV* Rotate injection sites Monitor for Hypoglycemia

The nurse assesses a client with coronary artery disease who has been hospitalized for three days. The nurse notes moderate peripheral edema bilaterally and crackles in the lungs. What should the nurse do first? Teach the client about a sodium-restricted diet. Request an order for daily weights. Discuss diuretic options with the provider. Review the intake and output since admission.

Review the intake and output since admission

What disease is 2-3X more common in women than men?

Rheumatoid arthritis

Risks in MS pts

Safety - fall risk, urinary urgency, depression, self esteem

A client has been prescribed losartan. What does the nurse assess related to this medication? Serum creatinine level Last normal menstrual period Post-void residual urine Apical heart rate Serum potassium level

Serum creatinine level (can increase SCr)

Onset of HHS

Slower (over several days)

K sparing diuretics

Spironolactone -antihypertensive

Nitroglycerin

Stable angina -SL, patch, IV *Vasodilator* Side effects: *headache*, lightheadedness, BP lower NI: monitor BP, rise slowly

Cell mediated branch

T lymphocytes activated by viruses, cancer, foreign tissue inactivate the foreigners; T-lymphocytes may attach/reject transplant organs - attack antigen (invaders) - may attack/reject transplant organs

What is HBA1C?

The average blood glucose levels for the last 2-3 months; can also be referred to as glycosylated hemoglobin.

assessment methods used to assess perfusion - pediatrics

Things to look for: - poor feeding - poor weight gain - fatigue - increased WOB - presence of abnormally large heart - abnormally high or low HR - cyanosis - clubbing

describe the different surgical interventions used to treat poor perfusion

Transluminal Balloon-Angiography Stent placement atherectomy CABG

The wound clinic nurse assesses a client with a non-healing foot ulcer. The nurse is aware that which comorbidities contribute to impaired healing? Select All That Apply: Peripheral vascular disease Cataracts Type II diabetes mellitus Diverticulitis Chronic asthma

Type II diabetes mellitus

What key cardiac lab values are elevated within a few hours after an MI?

Up to 80% of patients with acute MI will have an elevated troponin level within 2-3 hours of emergency department (ED) arrival, versus 6-9 hours or more with CK-MB

Hypertensive urgency vs. emergency

Urgency: over 180 or 120 without end organ damage Emergency: with end organ damage

Define Preload and Afterload

_Preload_: the end diastolic pressure when the ventricle has been filled. The load imposed on the heart prior to contraction and is the amount of blood the heart pumps per beat - The force that stretches the cardaic muscle prior to contraction _Afterload_: the work, post-contraction, required to move blood into the aorta; afterload is increased with narrowing of the aortic valve

Define systemic circulation

a *high pressure system* moving blood from the left side of the heart through aorta to the brain and other organs (from core to the periphery) left side of the heart

patho of myasthenia gravis

a chronic autoimmune disease that affects the neuromuscular junction and produces varying degrees of weakness of voluntary muscles

Define coronary circulation

a network of vessels that supply the heart muscle; branches off the aorta; works during diastole of the heart; comprises from left coronary artery and right coronary artery

MS (multiple sclerosis)

a progressive autoimmune-related disease involving demyelination of myelin sheath in the CNS - impairs transmission of nerve impulses - relapsing-remitting Primary progression: steadily progressing Secondary progression: *relapsing-remitting* *Presents differently in different people*

coronary atherosclerosis

abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen; underlying cause of coronary artery disease

Acquired Immune system

acquired through prior exposure to antigen through vaccination or contraction of the disease; broadly divided into two mechanisms: (1) the cell-mediated response, involving T-cell activation, and (2) effector mechanisms, involving B-cell maturation and production of antibodies.

which stage of infection involves rapid proliferation of pathogen and often includes fever, chills, tachycardia, and tachypnea?

acute illness stage

Define Ejection Fraction

amount of blood ejected from LV in 1 beat

Define Stroke volume

amount of blood the heart pumps out in 1 beat ~ 70ml/beat

Coronary artery disease

atherosclerosis of the coronary arteries that reduces the blood supply to the heart muscle

High risk of infection

autoimmune diseases -MS -RA

deep vein thrombosis (DVT)

blood clot in deep vein *Immobility *Often after surgery - virchow triad - endothelial damge -venous stasis -altered coagulation Tx: low molecular heparin

Antibiotics MOA

break the cell wall of bacteria (viruses do not have cell wall - they live in the host cell - cannot use antibacterials)

S/Sx of angina

chest pain unusual fatigue weakness shortness of breath dizziness nausea vomiting

angina

chest pain *caused by insufficient perfusion to the myocardial tissue*; precursor to myocardial infarction

Define Cardiac cycle

contraction and relaxation of the heart (systole & diastole)

which stage of infection involves repair of affected tissue, containment of infection and elimination of pathogen?

convalescent stage

primary hypertension

denotes high blood pressure from an unidentified cause; also called essential hypertension

S/sx of hypoglycemia

fatigue vision changes decline in LOC headache tachycardia irritability sweating (may be only sx if on beta blocker) neurologic changes, seizures, loss of consciousness, death.

Sx of infection

fever ↑HR ↑WBC (neutrophils) Resp: cough, mucus, sore throat, dehydration Systemic: vasodilate, change in LOC

*Long term complications of DM*

from not controlling BS *Macro-vascular -CAD -> MI - hyperglycemia (large molecules in blood -> Inc pressure in vessels -> HTN -> CAD) - TIA -> stroke Micro-vascular - damage to vessels -retinopathy (eyes) -nephropathy (kidneys) -neuropathy (CNS&PNS) - tingling, numbness, needle-like, parethesia - painless MI, gastric paresis, asymptomatic hypoglycemia, sexual dysfunction, infection

Silent Ischemia

heart blood flow is interrupted, but there is no pain involved

Cardiac output

heart rate x stroke volume

secondary hypertension

high blood pressure caused by the effects of another disease

Acute complications of DM

hyperglycemia hypoglycemia dawn phenomenon somogyi effect

During an assessment, the nurse learns that a client who denies any health problems has been taking cholestyramine for three years. For which health problem does the nurse create a care plan? Type 2 diabetes Hyperlipidemia Hypertension Atrial fibrillation

hyperlipidemia

Patho of RA

hypertrophy of the cells in synovial fluid which leads to uncontrolled inflammation ->destruction of synovial fluid -> loss of articular surface and motion -> pannus/fusion (hard fibrous tissue -> then bones fuse) -> muscle degeneration -> occlusive vasculitis, neuropathy & paresthesia (lack of sensation) - due to inflammation

Passive immunity

immunity transferred from another source such as from mother to fetus via the placenta or via breast milk.

common conditions involved with Metabolic syndrome

includes at least three of the following: insulin resistance central obesity dyslipidemia (triglycerides <150, HDL < 40-50) blood pressure consistently > 130/85 high levels of CRP (C-reactive protein) high fibrinogen level

Which stage of infection involves active replication with no symptoms?

incubation stage

Chain of infection

infectious agent reservoir portal of exit mode of transmission portal of entry susceptible host can be started and broken at any point

Infection

invasion of the body by a foreign organism

specific immune response

made up of the humoral and cell-mediated branch - Acquired

1st responders to the inflammatory response

neutrophils

MS tx

no cure -multidisciplinary team - PT, OT, Neuro Goals: 1. delay progression - reduce inflammation, suppress immune 2. sx management 3. tx acute exacerbation - prevent - keep disease under control

Tx of RA

no cure - minimize sx goals: ↓ pain ↓ swelling achieve remission ↓joint deformity minimalize disability

Pathophysiology of DKA

not enough insulin --> glucose cannot be used --> fat is instead used for energy --> production of ketones (byproducts of fat metabolism) --> ketones in blood -> metabolic acidosis

What is the small intestine's main role?

nutrient absorption